Preventive measures can help prevent blood clots when flying.
Q: My wife and I will be flying to Europe in a couple of weeks. We’re concerned about the possibility of developing blood clots in our legs.
Air passengers are hardly allowed to walk around during the flight anymore. Even standing for more than a few minutes is discouraged. Seats recline only a little bit, so it is hard to sleep. Is there anything we can do to reduce our risk?
A: There are a few things that will help. Make sure you wear compression hose for the flight. That can lower the risk of a clot. In addition, learn foot and leg exercises that can be done while seated, such as ankle circles, foot lifts and knee raises.
One other option is aspirin. For years, experts told us that aspirin was ineffective against blood clot formation in veins. A study in the European Journal of Internal Medicine ( January 2014) contradicted that belief. Low-dose aspirin reduces the likelihood of clot formation in high-risk patients. Ask your physician if aspirin would be safe during your flight.
Q: Recently you mentioned an interesting remedy — vinegar — for the burn associated with eating Japanese wasabi.
Reading that Q&A prompted me to pick up a to-go container of sushi rolls at the grocery store. When I opened it, I noticed the usual dollop of wasabi was not to be found. I enjoyed the treat until I picked up one of the pieces. I didn’t notice the big glob of wasabi was stuck to the underside.
I proceeded to eat it and immediately realized what happened. By then, though, my mouth was thoroughly coated and on fire.
I lunged for the kitchen cabinet and took a big gulp of apple cider vinegar. Voila! It stopped the burn immediately. Thank you for such practical advice; you saved one person from a lot of discomfort.
A: The compound responsible for that burning sensation is allyl isothiocyanate. You smell it almost as much as you taste it and could use it to clear the sinuses. We are delighted that the vinegar trick worked so well.
Q: You have written about people having a hard time stopping their antidepressants. More than a decade ago, I was having trouble getting one of my patients off Effexor. I wrote to the drug company for help, and the solution was ingenious. I have used it many times with patients trying to get off an SNRI-type antidepressant.
Fluoxetine (Prozac) has an extraordinarily long half-life. Prozac “covers” the receptors that are unsettled in the discontinuation syndrome.
I put the patient on the lowest dose of the problem antidepressant that is comfortable: no discontinuation symptoms. I start 20 mg of Prozac. In two weeks, I lower the dose of the problematic antidepressant, keeping the patient on Prozac.
I continue to taper the problematic antidepressant down to zero, taking as long as is needed. When my patient is completely off the problem drug, I keep the Prozac 20 mg for two more weeks, taper it to 10 mg for two weeks and then stop it. The long half-life of the Prozac gives me an automatic long taper, and the patient has no withdrawal symptoms.
A: Thank you for providing this detailed account on how to avoid symptoms like “head in a blender” that many people experience when stopping their antidepressant. There is more information about antidepressant pros and cons in our “Guide to Dealing With Depression.” It also provides suggestions for nondrug approaches that can be used with or without medication. It can be downloaded for $2 atpeoplespharmacy.com.
Q: I wanted to quit smoking, so my doctor prescribed Chantix. The bad dreams and depression made me question whether life was worth living. I feared going out in public because I would sometimes fly into a rage for no obvious reason. I am a laid-back, even-tempered guy normally.
Even though I lost my urge to smoke, I wonder whether the side effects of the drug are worth it. I am tapering off, but the anxiety, rage and depression are still scary.
A: The manufacturer of the stop-smoking drug varenicline (Chantix) warns that it may cause insomnia, abnormal dreams, depression, agitation, aggression, hostility and panic, as well as suicidal thoughts. This drug may not be appropriate for you.